My ankle injury is very inconsistent, what do I do?

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I broke my ankle this past spring, with 5 severe fractures. I had a bimalleolar ankle surgery, and had nine screws and a metal plate put in to stabilize the ankle. That was in March. I spent a few weeks in a wheel chair with hard casts, and did an air cast with crutches (progression to walking boot) for about 3 months. I stopped wearing the boot in early July, and completed my physical therapy a bit after. My left ankle was definitely weaker the rest of the summer, but it wasn't a major issue. Now, it's September, and I have barely been able to walk the past few days. I'll walk for about two minutes, then my ankle starts hurting a lot, and I have to limp to a seat. It's almost as if it forgets how to walk- it instinctively splays further left and puts a lot of pressure on the heel. But then, it will stop hurting as quickly as it started, and I'll be fine for a while, and then it comes back. I've tried changing what shoes I'm wearing (I thought maybe my boots were making it worse), whether or not my ankle is wrapped, and icing it in between, but nothing seems to work. I live on a college campus, so not walking is not an option! Please help!!!

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  • Posted

    Hi K8,

    Sorry to hear about your ankle injury. Yes, it can be a major life changer.

    Like you, I had a bimalleolar fracture (right ankle), but I dodged bullet on surgery-- what a blessing.

    I never had major problems in recovery, but I went through all phases you did-- immobilized in moon boot (air cast, etc, and known by some other not so pretty names by us patients who absolutely hate wearing CAM boots), scooting around in a wheel chair, progression to weight bearing steps using crutches, finally full weight bearing in boot and then in shoes, aided by a walking cane for a week or so.

    I experienced only minimal pain and swelling in recovery. Only vexing problem was PTTD from an injured post tibial tendon subsequent to fracture and sprain. I'm improving constantly at 8 months out-- completely normal walking gait, no limping or restrictions in movement, and usually 0 pain.

    Your mystery symptoms come as no surprise-- severely injured ankles are just not the same as pre-injury ankles, at least usually not for a long time (assuming full recovery). Unfortunately for some of us, restoration back to full normal ankle function never really happens, due to a variety of complicating factors (usually soft tissue damage that never gets properly healed due to tears, stretching, scar tissue formation, and also ankle joint alignment dysfunctions, etc). Ankles are complex body structures to begin with so a severe insult from fracture/sprains can introduce weird and surprising effects long after broken bones are mended. Just ask the average ankle patient about it and they will give you an earful.

    To me your symptomology suggests some soft tissue damage that you might need to seek medical attention for to find a cause and any relevant treatment.

    Since your ankle was immobilized for about 3 months in an air boot (and that after your cast came off) your ankle's muscles, ligaments, tendons, etc. were essentially sidelined and atrophied a bit. It will likely take more intense physiotherapy to strengthen, stabilize, and restore better ankle function. Much of PT you can do yourself with self-teaching aids on YouTube and web, but if you need to you could go back to your therapist and explain your ongoing problems and see what they say. Since your walking gait is unstable it suggests something is wrong now with your ankle's biomechanics.

    Your best bet might be to go to a highly competent foot doctor or podiatrist (orthopedic surgeons specialize mainly in broken bones) and have them do detective work to see what could be the cause.

    You are still relatively early in ankle recovery timeline so don't be unduly alarmed by this setback.

    But it is best not to procrastinate if ankle symptoms persist without improvement.

    Good luck to you. Please let us know your progress.

     

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    • Posted

      Thanks so much for your comment, kpower, it's so helpful. I'm going to try to take up swimming again to ease some ankle pressure rather than do cardio exercise, and if the problem persists, I'll get some soft tissue tests done. Thinking long term is definitely hard, especially when I still can't believe that a 2 second fall changed my life for over a year. I did call my PT today, and they suggested it might be necessary to switch back to my prescription sneakers, which have helped a bit, but I'll need a few days to see the full effect. Wish me luck!

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    • Posted

      K8,

      You're welcome for the advice. I find it insightful to hear other patient experiences and compare notes. Shared knowledge can be very useful. After all, we're all in the same boat (although some are on a more comfortable boat seat than others).

      I see more postings on your thread and they all seem to be good tips and advice.

      By cardio exercise, I assume you don't mean the kind that involves weight lifting, running, jumping, or other forceful weight-bearing exercises. Those are stressful for a post-injury ankle. Swimming, indoor cycling and rowing are much gentler to ankles and still get your heart rate up.

      I noted that type of footwear makes a difference in your comfort and pain level. That suggests you might need special shoe support until you pass the recovery hump and on are on the home stretch to good ankle function.

      I'm no expert on recovery shoe products but occasionally you will see posters remark about what works for them (hint-- unsupportive footwear like flat sandals and the like do not make the grade).

      Consider the possibility that you will need stronger foot supports like orthotic shoe inserts (I use an OTC orthotic that made a huge difference in comfort) and/or an ankle brace to give your ankle support so healing can continue.

      There seem to be at least 2 schools of thought on activity during recovery-- some think we should walk and stand in regular shoes as much as possible (as pain allows) and some think it is best to take a conservative approach and walk and stand for limited amounts of time (with support as needed) during early recovery (but still performing aggressive ankle physical therapy). I subscribe to last approach.

      Don't forget the proprioception (sense of balance) exercises in your PT regimen. Patients often are compromised by their injuries here (ankle fractures and sprains can injure or irritate nerves in ankle and foot that sense our foot's position in space relative to body stance and movement). Standing and balancing on injured foot is good exercise, as is use of wobble board (my favorite-- it's fun).

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  • Posted

    K8....   so sorry for your trouble.  I think seeing a doctor who specializes in foot and ankle is key and I'd get two opinions.   As far as tips and advice, I think "Perspective" and correct extractions are everything when it comes to foot and ankle injuries.   Because it is a complex joint and ...weight bearing, healing is very different than a non weigh bearing joint.   Get your docs advise, look at all options to include physical theropy.  And keep a long term slow perspective. Hang in there and sorry for your injury.  Hope this helps

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    • Posted

      Thanks so much for your response, supek99. I did some physical therapy after getting out of the boot, but it's definitely something to revisit. I think part of the issue might be that I'm pushing a lot of cardio exercise (I gained a lot of weight in early recovery that I'm trying to lose) so I'll probably switch to low impact exercise like swimming to ease some tension off the ankle. 

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  • Posted

    I'm hoping this is not a secondary injury from not maintaining an even gait whilst in that darn boot. Many complaints come from the secondary injury caused by not being give the information on healthy healing. I would be back to dr and nag till you get acceptable answers 

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    • Posted

      Thanks for your response! I did have an issue with the boot, but it was more of a hip injury that did take a while to get over. That was back when I walked with both feet splayed and had a terrible limp, but I got over that in about a month. I hope it didn't come back!

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  • Posted

    What does your Doctor and PT say?  I broke my ankle in 3 places w/2 plates.  Even though I have almost reached the five month mark I still wear a slim brace to give me some support and sometimes when I walk too much I have to use my cane to alleviate the pressure on my left ankle.  Five breaks seems excessive, so I would say it's gonna take you up to a year to really get your full strength back without it hurting anymore.  My advice is to keep an open conversation between your physical therapist and your doctor to find a solution,  and don't shy away from using your pain medication because I still use mine after a very long day.  I'll take one pain med at night so I can sleep. Good Luck!

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    • Posted

      Thanks for the comment! I was evaluated as passing out of PT in July, because I had improved back to at least 80% of my function. I think it's definitely part of the support issue- wearing sandals or dress shoes makes it impossible to walk, but I went back to wearing sneakers with prescribed orthopedic liners, and it got a bit better. I'll definitely get in touch with my orthopedic doctor ASAP to make sure it's not permanent damage 

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